Acute hyperkalemia is a severe electrolyte imbalance that can cause cardiac arrhythmias and endanger the patient's life. This article reports the anesthetic management information in a laparoscopic splenectomy case. The patient's preoperative diagnosis was upper gastrointestinal bleeding and chronic liver cirrhosis with decompensated stage. Preoperative serum electrolytes were normal. The anesthesia mode was general anesthesia by tracheal intubation. Intraoperative blood gas measurement revealed a sudden and severe elevation of potassium; however, the vital signs were stable, and potassium‑lowering treatment was immediately administered after ruling out pseudohyperkalemia. After the operation, the patient woke up safely, and the next day, the blood potassium was reduced to the normal range. This paper discusses and analyzes the possible causes of hyperkalemia to guide clinical work.